State of Arizona Acupuncture Board of Examiners

47 Pages·2016·1.63 MB·English

State of Arizona Acupuncture Board of Examiners
Board should improve its processes for issuing licenses and certificates,
revise its complaint resolution process, and improve its provision of public
information
Performance Audit and
Sunset Review
September 2016
Report 16-109
A Report to the Arizona Legislature
Debra K. Davenport
Auditor General
The Auditor General is appointed by the Joint Legislative Audit Committee, a bipartisan committee composed of
five senators and five representatives. Her mission is to provide independent and impartial information and specific
recommendations to improve the operations of state and local government entities. To this end, she provides
financial audits and accounting services to the State and political subdivisions, investigates possible misuse of
public monies, and conducts performance audits and special reviews of school districts, state agencies, and the
programs they administer.
The Joint Legislative Audit Committee
Representative John Allen, Chair Senator Judy Burges, Vice Chair
Representative Regina Cobb Senator Nancy Barto
Representative Debbie McCune Davis Senator Lupe Contreras
Representative Rebecca Rios Senator David Farnsworth
Representative Kelly Townsend Senator Lynne Pancrazi
Representative David Gowan (ex officio) Senator Andy Biggs (ex officio)
Audit Staff
Dale Chapman, Director Katherine Grzybowski, Team Leader
Marc Owen, Manager and Contact Person Erica C. Nickerson
Sharleen Heins
Contact Information
Arizona Office of the Auditor General
2910 N. 44th St.
Ste. 410
Phoenix, AZ 85018
[phone]
www.azauditor.gov
September 14, 2016
Members of the Arizona Legislature
The Honorable Doug Ducey, Governor
Mr. Pete Gonzalez, Executive Director
State of Arizona Acupuncture Board of Examiners
Transmitted herewith is a report of the Auditor General, A Performance Audit and Sunset
Review of the State of Arizona Acupuncture Board of Examiners. This report is in response to
an October 22, 2014, resolution of the Joint Legislative Audit Committee. The performance
audit was conducted as part of the sunset review process prescribed in Arizona Revised
Statutes §41-2951 et seq. I am also transmitting within this report a copy of the Report
Highlights for this audit to provide a quick summary for your convenience.
As outlined in its response, the State of Arizona Acupuncture Board of Examiners agrees
with all of the findings and plans to implement all of the recommendations.
My staff and I will be pleased to discuss or clarify items in the report.
Sincerely,
Debbie Davenport
Auditor General
cc: State of Arizona Acupuncture Board of Examiners members

Attachment

2910 NORTH 44th STREET • SUITE 410 • PHOENIX, ARIZONA 85018 • [phone] • FAX [phone]

REPORT HIGHLIGHTS
Performance Audit and Sunset Review
September 2016
State of Arizona Acupuncture Board of Examiners
CONCLUSION: The State of Arizona Acupuncture Board of Examiners (Board) regulates the practice of acupuncture
in the State by issuing acupuncture licenses and auricular acupuncture certificates, investigating and resolving
complaints, and providing information to the public about licensees and certificate holders. We found that the
Board has not consistently obtained all licensing information before issuing licenses, and has renewed some
licenses without verifying compliance with continuing education requirements. In addition, although the Board
generally resolves complaints in a timely manner, the Board’s complaint resolution process is not adequately
designed to protect the public and the Board has not developed complaint-handling policies and procedures to
appropriately guide staff. Finally, the Board did not consistently provide accurate information about licensees and
certificate holders over the phone.
Board should strengthen its license and certification processes
Board issued some licenses without collecting or verifying required information—State law requires all
state licensing boards to collect documentation from applicants supporting their lawful presence in the U.S. before these
boards issue or renew licenses. However, the Board has not consistently obtained such documentation. We reviewed a
random sample of 12 initial licenses and certificates issued between August 2010 and March 2015, and 26 licenses and
certificates renewed between January 2014 and January 2016, which included 3 licensees who were not U.S. citizens,
and found that the Board renewed 2 of the 3 licensees without obtaining appropriate or updated documentation of lawful
presence in the U.S. One of the licensees provided a passport, but not the required visa, while the other licensee did
not provide updated documentation after her permanent resident card expired. Our review of an additional sample of six
active licensees who were not U.S. citizens also revealed that the Board issued initial licenses to two of these licensees
without obtaining documentation required by law.
Board renewed licenses without verifying compliance with continuing education requirements—
Licensees are required to complete 15 hours of approved continuing education annually in order to renew their licenses.
The Board randomly audits compliance and a licensee must provide documentation of compliance at the time of the
audit. We reviewed a random sample of 21 licenses that were renewed between January 2014 and January 2016 and
found that the Board improperly issued renewals for several years to one licensee who did not certify his compliance with
the continuing education requirement on his renewal applications. We also reviewed a random sample of nine licensees
that the Board had selected for audit between 2010 and 2015, and found that the Board renewed two of the licenses
without ensuring that the licensees met continuing education requirements.
Board should develop and implement policies and procedures and better track citizenship
documentation—Although the Board has established some policies and procedures for reviewing and approving
licenses and certificates, board staff lacked clear guidance about what specific licensing documentation to collect and
how to verify it. The Board began developing additional policies and procedures for reviewing and approving renewal
licenses during the audit and should continue to develop and implement them.
In addition, the Board does not have an adequate process for tracking citizenship documentation for non-U.S. licensees
whose documentation may expire and need to be updated. This information is currently maintained in separate documents,
which the Board must check manually, instead of the Board’s licensing database, which the Board could use to generate
lists of licensees whose citizenship documentation has expired. In addition, the Board uses an outdated citizenship form
that licensees and certificate holders complete to demonstrate lawful presence in the U.S. that does not reflect current
statutory requirements for documentation.
Recommendations
The Board should:
• Continue to develop and implement policies and procedures for reviewing and approving initial and renewal license
and certificate applications; and
• Develop a more reliable system for tracking non-U.S. licensees’ citizenship documentation and update its citizenship
form to reflect current statutory requirements.
Board generally resolved complaints in a timely manner, but should
improve its complaint resolution process
Board should improve its complaint resolution process—We reviewed all ten complaints resolved by the
Board between July 1, 2012 and December 14, 2015, and found that the Board generally resolves complaints in a timely
manner; however, some of the Board’s rules and practices do not adequately protect the public. For example, although
not authorized by law, the Board’s rules require the Board to dismiss a complaint if it is not filed within 90 days of an alleged
violation. In addition, rules permit the Board to close a complaint if a complainant requests to withdraw it, even when
the Board has not completed its investigation. For two of the ten complaints we reviewed, one for an alleged fraudulent
billing and another regarding a monetary dispute, the Board stopped its investigation and closed the complaints when
the complainants requested to withdraw the complaint or indicated they had reached an agreement with the licensee.
Further, rule requires the Board to determine jurisdiction before it proceeds with an investigation, but for nine of the ten
complaints we reviewed, the Board did not determine whether it had jurisdiction before undertaking the investigation.
Board lacks adequate guidance for resolving complaints—The Board has not developed policies and
procedures to guide staff in investigating complaints, such as conducting interviews or reviewing applicable documentation.
In addition, the Board does not have policies or procedures in place for how to proceed when a licensee does not respond
to a complaint, or for developing, reviewing, and executing consent agreements. Finally, although statute requires the
Board to notify a licensee’s employer, if any, of disciplinary action initiated against the licensee, the Board does not have
any policies and procedures for notifying employers.
Recommendations
The Board should:
• Remove its complaint resolution process from rules;
• Develop and implement comprehensive policies and procedures for its complaint resolution process; and
• Modify its application forms to include employment information.
Board should improve its provision of information to public
Although the Board provides appropriate licensee information on its website, when we placed four calls to request
complaint and disciplinary history information on three licensees and one certificate holder, staff provided inaccurate
information for two of these calls. For one call, board staff inaccurately reported that a complaint was dismissed when the
complaint actually resulted in a nondisciplinary letter of concern. For the other, board staff reported that a licensee had
three dismissed complaints when the actual number was five. These errors were likely made because the information was
inaccurately recorded in the Board’s licensing database.
Recommendation
The Board should implement its recently developed policies and procedures for providing information to the public and
ensure that the information in its licensing database is accurate.
Arizona Auditor General State of Arizona Acupuncture Board of Examiners | September 2016 | Report 16-109
A copy of the full report is available at: www.azauditor.gov | Contact person: Marc Owen [phone]
TABLE OF CONTENTS
Introduction 1
Chapter 1: Licensing and certification 5
Board has issued some licenses without collecting or verifying required information 5
Board should strengthen its license and certification processes 7
Board issued licenses and certificates in a timely manner, but should improve its tracking 7
Recommendations 8
Chapter 2: Complaint resolution 11
Board should improve its complaint resolution process 11
Board generally resolved complaints in a timely manner 15
Recommendations 16
Chapter 3: Public information 19
Board should improve its provision of public information over the phone 19
Recommendations 20
Sunset factors 21
Recommendations 28
Appendix: Methodology a-1
Agency Response
Table
1 Schedule of revenues, expenditures, and changes in fund balance
Fiscal years 2014 through 2016
(Unaudited) 3
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Arizona Auditor General State of Arizona Acupuncture Board of Examiners | September 2016 | Report 16-109
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INTRODUCTION
Scope and objectives
The Office of the Auditor General has conducted a performance audit and sunset review of the State of Arizona
Acupuncture Board of Examiners (Board) pursuant to an October 22, 2014, resolution of the Joint Legislative
Audit Committee. This audit was conducted as part of the sunset review process prescribed in Arizona Revised
Statutes (A.R.S.) §41-2951 et seq. This audit addresses the Board’s licensing and complaint resolution processes
and its provision of information to the public. It also includes responses to the statutory sunset factors.
Mission and responsibilities
The Board was established in 1998 to regulate the practice of acupuncture. Its mission is to protect the health,
safety, and welfare of the public by regulating and maintaining standards of practice in the field of acupuncture.
The Board’s responsibilities include:
Acupuncture is the puncturing of the skin with thin,
• Issuing licenses and certificates to qualified
solid needles, stimulating the needles to produce a
applicants—The Board licenses acupuncturists
positive therapeutic response, and the use of related
and certifies auricular (ear) acupuncturists (see
therapies, such as the thermal or magnetic stimulation
textbox). According to board records, as of June
of acupuncture points and energy pathways.
20, 2016, the Board had 598 active licensed
acupuncturists and 38 active certified auricular
Auricular acupuncture is a therapy to treat alco-
acupuncturists. According to board records, the
holism, substance abuse, or chemical dependency,
Board approved 60 new acupuncture licenses
which involves inserting needles into specific points in
and 9 new auricular certificates in calendar year
the outer ear.
2015. All licensees and certificate holders are
required to renew their license and/or certificate Source: Auditor General staff summary of A.R.S. §§32-3901 and
annually. 32-3922, and Arizona Administrative Code (AAC) R4-8-101.
• Investigating and resolving complaints—The Board is required to investigate complaints against
licensees and certificate holders and can take statutorily authorized nondisciplinary or disciplinary action,
as needed, such as issuing a letter of concern or placing a licensee on probation (see page 11 for more
information on nondisciplinary and disciplinary options). According to board records, the Board opened a
total of ten complaints against licensed acupuncturists between July 1, 2012 and December 14, 2015.1 The
Board did not receive any complaints against auricular acupuncturists during this time frame. Of the ten total
complaints, seven were dismissed, two resulted in nondisciplinary action, and one resulted in disciplinary
action.2
1
Auditors determined that one complaint was against an acupuncturist who had an expired license (see Complaint resolution, page 11).
2
During this same period, the Board also investigated 27 complaints against individuals alleged to have practiced acupuncture without being
licensed by the Board. Twenty-six of these 27 complaints were received in fiscal year 2014, of which 21 complaints were against physical
therapists alleged to have practiced acupuncture in the form of dry needling. According to Arizona law, dry needling is a skilled intervention
performed by a physical therapist that uses a thin needle to penetrate the skin and stimulate underlying neural, muscular, and connective
tissues. The Board ultimately dismissed all 21 complaints against the physical therapists. Laws 2014, Ch. 220, modified the statutes of the
Arizona Board of Physical Therapy to add that physical therapists could face disciplinary action for performing dry needling if the physical
therapists failed to demonstrate professional standards of care and training and education qualifications, as established by the Arizona Board
of Physical Therapy in rule. One complaint was against a licensed massage therapist and was also dismissed. As of January 26, 2016, two of
the remaining five complaints were dismissed, two were still under investigation, and one had been forwarded for prosecution to the Maricopa
County Attorney’s Office.
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• Providing information to the public—The Board provides information about licensees and certificate
holders, including disciplinary history, on its website. In addition, the Board publishes public meeting
agendas and minutes and a newsletter on its website. Finally, board staff respond to requests for public
information, including requests made by phone, regarding the license status and disciplinary history of
licensed acupuncturists and certified auricular acupuncturists.
Organization and staffing
The Board is required by A.R.S. §32-3902 to consist of the following nine governor-appointed members: four
licensed acupuncturists; three consumer members who are not employed in a health profession; and two members
who are licensed in chiropractic, medicine and surgery, naturopathic medicine, osteopathy, or homeopathy. As
of May 2016, the Board had one consumer member vacancy. Board members are appointed for 3-year terms.
The Board was authorized 1 full-time equivalent staff position for fiscal year 2016, which was filled by its executive
director as of May 2016.
Budget
The Board does not receive any State General Fund appropriations. Rather, its revenues consist primarily of
license and certification fees. Statutes require the Board to remit to the State General Fund all monies collected
from civil penalties and 10 percent of all other revenues, and to remit the remaining 90 percent to the Acupuncture
Board of Examiners Fund. As shown in Table 1 (see page 3), the Board’s fiscal year 2016 net revenues totaled
approximately $161,200. The Board’s expenditures totaled approximately $142,000 in fiscal year 2016, the
majority of which were personnel costs. The Board’s fiscal year 2016 ending fund balance was nearly $167,700.
Arizona Auditor General State of Arizona Acupuncture Board of Examiners | September 2016 | Report 16-109
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